Development Of Gestational Hypertension Research Articles

Finger pulse plethysmography predicts gestational hypertension, preeclampsia and gestational diabetes.

Pregnancy complications related to hypertension can affect both mother and newborn. Pulse wave attenuation (PWA) captured through fingertip photoplethysmography (PPG) provide valuable insights into maternal acute hemodynamic and autonomic vascular function. Here, we quantify the nocturnal dynamics of PWA during early pregnancy and assess their association with the development of gestational hypertension, preeclampsia and gestational diabetes. PWA dynamics were assessed on overnight polysomnography-derived PPG signals from a cohort of 2714 pregnant women (mean age: 26.8 ± 5.5 years) enrolled in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). We determined the average duration (PWA duration ) and depth (PWA depth ) of PWA events in all women. Odds ratio (OR) analysis-adjusted common confounders indicates that an average PWA duration greater than 8.74 s was associated with the increased risk of gestational hypertension [OR = 1.75 (1.27-2.39), P < 0.001]. Similarly, average PWA depth greater than 1.19 was associated with an increased risk of preeclampsia [OR = 1.53 (1.01-2.33), P = 0.045] and gestational diabetes [OR = 1.66 (1.01-2.73), P = 0.044]. PWA attenuation dynamics during early pregnancy predict the risk of developing gestational hypertension and diabetes condition for women in their later trimesters. Potentially obtainable from smart wearable consumer devices, PWA analysis offers a low-cost, accessible and scalable marker that can enhance the management of pregnancy-induced cardiometabolic issues.

Long-Term Predictors of Gestational Hypertension: Placental Growth Factor, Pregnancy-Associated Plasma Protein-A and Free Beta-Hcg Versus Mean Arterial Pressure and Uterine Artery Doppler Versus a Combination of Both: A Comparative Study.

According to WHO, hypertensive disease is the leading cause of direct maternal mortality accounting for 10-25% in developing countries (James in Heart, 90(12):1499-504). This study compares the combinations of mean arterial pressure (MAP) and uterine artery doppler (UAD) versus serum-free β HCG, pregnancy-associated plasma protein-A, and placental growth factor (PlGF) versus a combination of all variables at 11 to 13+6 as long-term predictors of pregnancy-induced hypertension (PIH). A prospective, observational cohort study recruited 97 primigravidae at 11 to 13+6weeks gestation at GMCH. Follow-up was done at 32-34weeks and before delivery. Development of PIH, mode of delivery, birthweight, maternal and fetal adverse outcomes were documented, analyzed and compared among three groups. In Group A-biophysical markers, Group B-biochemical markers and in Group C all variables were used. The mean age, maternal weight, height and BMI of patients developing gestational hypertension were 30 ± 5years, 64.3 ± 12.5kg, 155.8 ± 5.5cm and 26.4 ± 4.1, respectively. Out of the 3, Group C is the best screening test for predicting the overall chance of development of gestational hypertension with a sensitivity of 97.37% and specificity of 38.98% (p < 0.0001). A mild negative correlation is seen between PlGF levels and severity of PIH (p-0.0382). MAP and UAD can be easily incorporated into the infrastructure of most hospitals. If the biochemical test kits are made available at a low cost through available programs such as JSSK, it can bring down the MMR by preventing gestational hypertension.

Association of Elevated Serum Aldosterone Concentrations in Pregnancy with Hypertension.

Emerging evidence indicates a previously unrecognized, clinically relevant spectrum of abnormal aldosterone secretion associated with hypertension severity. It is not known whether excess aldosterone secretion contributes to hypertension during pregnancy. We quantified aldosterone concentrations and angiotensin peptides in serum (using liquid chromatography with tandem mass spectrometry) in a cohort of 128 pregnant women recruited from a high-risk obstetrics clinic and followed prospectively for the development of gestational hypertension, pre-eclampsia, superimposed pre-eclampsia, chronic hypertension, or remaining normotensive. The cohort was grouped by quartile of aldosterone concentration in serum measured in the first trimester, and blood pressure, angiotensin peptides, and hypertension outcomes compared across the four quartiles. Blood pressures and body mass index were greatest in the top and bottom quartiles, with the top quartile having the highest blood pressure throughout pregnancy. Further stratification of the top quartile based on increasing (13 patients) or decreasing (19 patients) renin activity over gestation revealed that the latter group was characterized by the highest prevalence of chronic hypertension, use of anti-hypertensive agents, pre-term birth, and intrauterine growth restriction. Serum aldosterone concentrations greater than 704 pmol/L, the 75th percentile defined within the cohort, were evident across all categories of hypertension in pregnancy, including normotensive. These findings suggest that aldosterone excess may underlie the development of hypertension in pregnancy in a significant subpopulation of individuals.

THU348 Thyroid Dysfunction And Diabetes In Pregnancy - Is There A Link?

Abstract Disclosure: R.K. Sahay: Speaker; Self; Novo Nordisk, Roche Diagnostics. S.A. Kalam: None. N. Kudugunti: Speaker; Self; Novo Nordisk. S. Togarla: None. Background: The Indian subcontinent has shown higher prevalence for both thyroid dysfunction and diabetes complicating pregnancy when compared to the Western population. The association between both has been studied in multiple small studies which have however shown discordant results. Hence the need for exploring this further. Aims: To assess the proportion of women with thyroid autoimmunity and thyroid dysfunction in pregnancy complicated by diabetes mellitus and determine association of the same with diabetes in pregnancy and maternal and perinatal outcomes. Methods: 150 pregnant women with gestational/pregestational diabetes were enrolled in this cross sectional study and the proportion of those with thyroid dysfunction were assessed. Thyroid autoimmunity was evaluated in the same population using antiTPO and anti-thyroglobulin antibodies. The proportion of women with thyroid autoimmunity as well as thyroid dysfunction was calculated and the association of these with diabetes in pregnancy was evaluated along with maternal and perinatal outcomes. The same tests were done on 26 pregnant women without diabetes who served as controls. Results: The mean age of the study population was 26.62 ± 4.34 years. 56% were diagnosed with GDM and the rest had pre-GDM. 26.6% of the study population were diagnosed with hypothyroidism. Of these,45% were newly diagnosed during the current pregnancy. The prevalence of antiTPO antibody positivity was found to be 9.33% whereas that of anti-thyroglobulin antibody was 3.33%. Maternal and perinatal complications were higher in the group with combined endocrinopathy with gestational hypertension and preterm delivery showing statistically significant increase among the latter group. Among those women with combined endocrinopathy who developed gestational hypertension,76.9% had GDM. All of them were found to have subclinical hypothyroidism which was newly diagnosed in third trimester. Conclusion: The prevalence of hypothyroidism in pregnancy complicated by diabetes is higher than the prevalence in normal pregnancy. Undiagnosed subclinical hypothyroidism was found to be strongly associated with development of gestational hypertension. Our study emphasises the fact that women with diabetes in pregnancy should receive early and periodic screening for thyroid dysfunction in pregnancy. Presentation: Thursday, June 15, 2023

Pregnancy-Associated Plasma Protein-A: Its Significance as a Single Biomarker for Adverse Obstetric Outcomes

OBJECTIVES: Low levels of pregnancy-associated plasma protein-A in pregnant women linked to unhealthy placentation and a spectrum of maternal and fetal complications. Its assessment as a single biomarker has the potential to identify high-risk pregnancies. This prospective observational study was conducted to find a correlation between low pregnancy-associated plasma protein-A levels in the first trimester of pregnancy with various obstetric outcomes to establish if it can be used as a single biomarker for counseling couples. STUDY DESIGN: The study was conducted at Base Hospital, Delhi Cantt. Maternal serum pregnancy-associated plasma protein-A levels were assessed at 11 to 13+6 weeks of gestation, converted in multiples of the median and patients were followed till delivery. Maternal outcomes were recorded in terms of abortions, development of gestational hypertension, gestational diabetes, preeclampsia, placental abruption, fetal growth restriction, fetal demise, neonatal intensive care unit admission, etc., and analyzed to find an association with levels first trimester of pregnancy-associated plasma protein-A. RESULTS: Low pregnancy-associated plasma protein-A levels showed a statistically significant association with gestational hypertension, preeclampsia, abortion, fetal demise, and also for adverse neonatal outcomes like APGAR &lt;5 at 1 min, fetal growth restriction, neonatal intensive care unit admission, and perinatal deaths. No significant association was observed for preterm delivery, gestational diabetes, and placental abruption. CONCLUSION: Serum pregnancy-associated plasma protein-A levels in the first trimester of pregnancy have the potential of being utilized as a validated marker for adverse pregnancy outcomes. Early identification of such pregnancies can help in optimizing feto-maternal outcomes through closer surveillance, timely intervention, and referral to tertiary care centers. Further research would help the fraternity in developing a prediction model.

Abstract 067: Suppression Of The Renin Angiotensin Aldosterone System In Human Hypertensive Pregnancy

In healthy pregnancy, elevated renin activity stimulates aldosterone release via angiotensin II (Ang II) signaling. Despite the known importance in blood volume expansion, mechanisms of aldosterone secretion during pregnancy are not well understood. In vitro / in vivo evidence that aldosterone concentrations are disproportionally elevated compared to renin activity suggest altered sensitivity to Ang II or nonangiotensin stimulation during pregnancy. We used a novel LC-MS/MS-based methodology to quantify serum biomarkers of the renin-angiotensin-aldosterone system (RAAS) in order to evaluate renin-aldosterone relationships in healthy and hypertensive human pregnancy. We recruited 73 pregnant individuals with no known hypertension and followed them prospectively for the development of gestational hypertension or pre-eclampsia outcomes (HYP, n=27), no adverse outcomes (No AO, n=27), or adverse outcomes that were non-hypertensive (AO, Non-HYP, n=20). Concentrations of Ang peptides I and II and aldosterone were quantified from first and third trimester serum. Blood pressure was elevated starting in the first trimester in women who developed HYP outcomes (P&lt;0.01). Renin activity (calculated by [Ang I + Ang II]) and aldosterone concentrations significantly increased from first to third trimester in No AO and AO Non-HYP (renin activity, 30% and 37% increase; aldosterone, 230% and 238% increase, respectively, P&lt;0.001). This was in contrast to HYP pregnancies, where renin activity and aldosterone increased by 19% and 70%, respectively, and were not significant(P=0.54). Further, third trimester aldosterone was significantly lower, median (interquartile range) = 492 (260 - 827) pmol/L compared to No AO = 828 (467-1778) and AO Non-HYP = 1046 (527 - 1368) pmol/L (P&lt;0.01). There was a significant increase in the aldosterone to Ang II ratio over gestation in No AO and AO Non-HYP pregnancies(P&lt;0.01), but not HYP. Taken together, we propose that activity of the RAAS is suppressed in pregnancies that develop hypertension, likely a compensatory response to already-elevated BP. Further, non-hypertensive pregnancy is characterized by a preferential increase in aldosterone, where mechanisms may be impaired in pregnancies that develop hypertension.

Activation of the Renin-Angiotensin-Aldosterone System Is Attenuated in Hypertensive Compared with Normotensive Pregnancy.

Hypertension during pregnancy increases the risk of adverse maternal and fetal outcomes, but the mechanisms of pregnancy hypertension are not precisely understood. Elevated plasma renin activity and aldosterone concentrations play an important role in the normal physiologic adaptation to pregnancy. These effectors are reduced in patients with pregnancy hypertension, creating an opportunity to define the features of the renin-angiotensin-aldosterone system (RAAS) that are characteristic of this disorder. In the current study, we used a novel LC-MS/MS-based methodology to develop comprehensive profiles of RAAS peptides and effectors over gestation in a cohort of 74 pregnant women followed prospectively for the development of gestational hypertension and pre-eclampsia (HYP, 27 patients) versus those remaining normotensive (NT, 47 patients). In NT pregnancy, the plasma renin activity surrogate, (PRA-S, calculated from the sum of Angiotensin I + Angiotensin II) and aldosterone concentrations significantly increased from the first to the third trimester, accompanied by a modest increase in the concentrations of angiotensin peptide metabolites. In contrast, in HYP pregnancies, PRA-S and angiotensin peptides were largely unchanged over gestation, and third-trimester aldosterone concentrations were significantly lower compared with those in NT pregnancies. The results indicated that the predominant features of pregnancies that develop HYP are stalled or waning activation of the RAAS in the second half of pregnancy (accompanied by unchanging levels of angiotensin peptides) and the attenuated secretion of aldosterone.

Effect of placental location on intra-uterine growth restriction and gestational hypertension

OBJECTIVES: To evaluate the relationship between uterine placental location and fetal growth restriction and gestational hypertension.&#x0D; MATERIALS AND METHOD: A prospective cross-sectional study done in the Department of Radiology of the University of Calabar Teaching Hospital (UCTH), Calabar, within a 4-month period. The study involved a total of 100 singleton pregnant women between 20 to 40 weeks of gestation who were aged 20 to 39 years. Analysis of the data was done using the statistical package for social science (SPSS) version 20 Inc. Chicago, IL.&#x0D; RESULTS: The frequency distribution of the placental locations were: anterior – 35%, postero-fundal – 36%, antero-fundal – 18% and posterior – 11%. The highest mean head circumference to abdominal circumference ratio (HC/AC) was seen in subjects with posterior placental location (1.03 ± 0.09), lowest mean estimated fetal weight (EFW) was seen in subjects with antero-fundal placental location (1.87 ± 0.92 kg) while the highest mean systolic and diastolic blood pressure were seen in subjects with postero-fundal placental location (113.89 ± 10.50 mmHg and 66.61 ± 7.07 mmHg) respectively. The lowest mean HC/AC was noted in subjects with anterior placental location (1.01 ± 0.08), the highest EFW was noted in subjects with postero-fundal placental location (2.26 ± 1.03 kg) while the lowest mean systolic and diastolic blood pressure were noted in subjects with posterior placental location (109.09 ± 5.39 mmHg and 61.82 ± 4.05 mmHg) respectively. There was no significant correlation between placental location and HC/AC, EFW, systolic blood pressure and diastolic blood pressure (p = 0.744, p = 0.567, p = 0.671, p = 0.936) respectively.&#x0D; CONCLUSION: Placental location in the uterus has no relationship with intrauterine growth restriction and the development of gestational hypertension in the second half of singleton pregnancies.&#x0D;

Correlation of Mid-Trimester Spot Urinary Albumin: Creatinine Ratio With the Adverse Pregnancy Outcome.

Background Urinary albumin creatinine ratio (ACR) is a known method of measurement of microalbuminuria. Microalbuminuria may be an early marker of endothelial dysfunction which can lead to various complications during the course of pregnancy. The objective of our study was to evaluate the correlation of mid-trimester spot urinary ACR with the pregnancy outcome. Material and methods We performed a prospective cohort study in the department of Obstetrics & Gynaecology,All India Institute of Medical Sciences, Bhopal, for a period of one year. We studied 130 antenatal women between 14 and 28 weeks of gestation after obtaining written informed consent. The patients with ongoing urinary tract infection (UTI), pre-existing hypertension, or diabetes were excluded. Urinary samples were examined for spot ACR, and the women were followed untildelivery. Primary maternal outcomes were development of gestational hypertension, pre-eclampsia, gestational diabetes mellitus (GDM), and preterm labour. Neonatal outcome was assessed in terms of birth weight, the APGAR (Appearance, Pulse, Grimace, Activity, Respiration) scores, and neonatal intensive care unit (NICU) admission. Results In our study, mean urinary ACR was 19.07±12.94 mcg/mg and median urinary ACR (IQR) was 18 (9.43-25.25) mcg/mg. Prevalence of microalbuminuria in our study was 19.2%. It was observed that urinary ACR level was significantly higher in women with maternal complications like GDM, gestational hypertension, preeclampsia, and preterm labour. Also, mean urinary ACR of women who developed preeclampsia was higher (37.53±31.85)compared to women who developed gestational hypertension (27.40±9.71). Urinary ACR level was significantly higher in babies with low APGAR scores and in babies who needed NICU admission (p value < 0.05). The sensitivity and specificity of spot urinary ACR to predict GDM and preeclampsia were found to be good as calculated from the receiver operating curve. Conclusion We found definite correlation of higher values of mid-trimester urinary ACR with the adverse pregnancy outcome.

PREDICTION OF PREECLAMPSIA BY UTERINE ARTERY DOPPLER

Objective: To evaluate the role of mean pulsatility index by rst trimester uterine artery doppler in prediction of preeclampsia. A prospective observational study was conducted in a tertiary c Methodology: are center. Of 200 women screened, 136 women met eligible criteria and 130 consented for participation in the study. In addition to nuchal translucency and crown-rump length, mean uterine artery pulsatility index (PI) was measured at 11–13+6 weeks, and women were followed up till delivery to observe the development of gestational hypertension, preeclampsia and fetal growth restriction (FGR). Categorical variables were analyzed using ROC curve, and P≤0.05 (5%) was used to calculate signicance. Among 130 women followed t Results: ill delivery, 9 (6.92%) had mean PI &gt;95% and 121 (93.08%) had normal Doppler. A signicantly higher number of women with PI ≥95% had preeclampsia (55.55%) (p &lt; 0.001), and the sensitivity of PI in prediction of preeclampsia was 55.55% with specicity of 98.80%. No association was found between PI and FGR (p = 0.228). Conclusion: This study showed a positive association with the development of preeclampsia . The predictive accuracy of rst trimester uterine artery Doppler using PI with cutoff of &gt;95% has low sensitivity in prediction of preeclampsia (55.55%) but it has high specicity(98.80%) for prediction of PE(Preeclampsia).

Estimating the levels of β HCG during second trimester to alert hypertensive disorders of pregnancy

ding Author principalnursing@saveetha.com ABSTRACT Back Ground: The current study aims to estimate the levels of β HCG among antenatal mothers during second trimester to alert hypertensive disorders during pregnancy. Methods And Materials: The quantitative approach with prospective cohort study was conducted in the host institution of Saveetha Medical College And Hospitals. A total of 100 study participants were recruited using purposive sampling technique based on the inclusion criteria, the demographic and clinical data was collected by using a self-structured questionnaire and the levels of serum βHCG was estimated during13-26 weeks and the development of gestational hypertension was monitored for all the study participants by following them till 27-38 weeks of gestation Results: The outcome of study results identified that, the mean score of serum β-HCG levels was 99784.51±168540.29.The minimum score was 34765.0 and the maximum score of 1383678.0. The median was 69056.0. Majority of second trimester mothers with elevated Serum β-HCG levels had an elevated levels of proteinuria, systolic and diastolic pressure associated with pedal edema during their third trimester of pregnancy. Conclusion: This study demonstrates a positive association between increased second trimester Serum β-HCG levels and hypertensive disorders during pregnancy.

ASSOCIATION OF GESTATIONAL WEIGHT GAIN AND GESTATIONAL HYPERTENSION AMONG ANTENATAL MOTHERS ATTENDING A TERTIARY CARE CENTRE, SOUTH KERALA

Background: Maternal mortality and morbidity remain signicant public health concerns, despite modern perinatal care. Excessive and insufcient gestational weight gain have been associated with several adverse pregnancy outcomes, of which hypertensive disorders of pregnancy constitute 10%. The aim of the study was to nd an association between ges Objective: tational weight gain(GWG) and the development of gestational hypertension. This cross-sectional study included all the antenatal women attending the OPD of the obstetrics department in Dr SMCSI medical college from June 2018 to October 2019. Their BMI was calculated and based on that, these patients were categorized into 4 groups as normal weight, underweight, overweight, and obese. Their weight gain was recorded on each visit and monitored. Antenatal complications were noted and followed up for the development of gestational hypertension. Among 930 antenatal Results: women selected, all mothers with normal BMI were in the recommended weight gain group. Less than recommended weight gain mothers were mostly underweight (80.6%) and more than recommended mothers were overweight (66.6%). In our study there were a signicant number of mothers with gestational hypertension 22.6% who had more than the recommended amount of weight gain (p=0.005) Gestational hypertension Conclusion: was seen more among mothers with more than the recommended amount of weight gain

Thyroid status in pregnant women with pregnancy induced hypertension – A case control study

Introduction: Pregnancy induced hypertension (PIH) is an important cause of maternal and fetal morbidity and mortality affecting 5-10% of pregnancies. PIH is more frequently associated with elevated TSH (Thyroid-stimulating hormone). Thyroid dysfunction plays an important role in the development of gestational hypertension. However, this relationship remains unclear. The study was performed to evaluate the thyroid status in pregnant women with PIH and normal pregnant women. Methodology: This was a hospital based observational case control study done in Dr M K Shah Medical College, Ahmedabad. Total 100 pregnant women were included, out of them 50 PIH women were included in the case study group and 50 normotensive healthy pregnant women were included in the control group. After taking written consent, thyroid profile (TSH, free T3 and free T4) were measured in all 100 subjects. Results: Women with PIH had higher TSH levels and lower free T3 and free T4 as compared to normotensive pregnant women. There was a significant association between hypothyroidism and PIH cases. There was a significant positive correlation between TSH and systolic BP (r=0.42) and diastolic BP (r=0.52). Conclusion: PIH women are at greater risk of decreased thyroid function. Therefore, PIH women should be monitored for thyroid levels regularly.

Conventional natural killer cells control vascular remodeling in the uterus during pregnancy by acidifying the extracellular matrix with a2V.

Vascular remodeling within the uterus immediately before and during early pregnancy increases blood flow in the fetus and prevents the development of gestational hypertension. Tissue-resident natural killer (trNK) cells secrete pro-angiogenic growth factors but are insufficient for uterine artery (UtA) remodeling in the absence of conventional natural killer (cNK) cells. Matrix metalloproteinase-9 (MMP9) is activated in acidic environments to promote UtA remodeling. We have previously shown that ATPase a2V plays a role in regulating the function of cNK cells during pregnancy. We studied the effect of a2V deletion on uterine cNK cell populations and pregnancy outcomes in VavCrea2Vfl/fl mice, where a2V is conditionally deleted in hematopoietic stem cells. Conventional NKcells were reduced but trNK cells were retained in implantation sites at gestational day 9.5, and UtA remodeling was inhibited despite no differences in concentrations of pro-angiogenic growth factors. The ratio of pro-MMP9 to total was significantly elevated in VavCrea2Vfl/fl mice, and MMP9 activity was significantly reduced. The pH of implantation sites was significantly elevated in VavCrea2Vfl/fl mice. We concluded that the role of cNK cells in the uterus is to acidify the extracellular matrix (ECM) using a2V, which activates MMP9 to degrade the ECM, release bound pro-angiogenic growth factors, and contribute to UtA remodeling. Our results are significant for the understanding of the development of gestational hypertension.

Health-promoting behaviors and intermediary social determinants of health in low and high-risk pregnant women: an unmatched case-control study

BackgroundHigh-risk pregnancies require increased health and care resources to reduce the severe perinatal consequences. The adoption of a health-promoting lifestyle and social determinants is an important strategy for achieving the desired outcomes of pregnancy. This study aimed to compare intermediate determinants of social health in low and high-risk pregnant women.MethodsThis unmatched case-control study was performed with a ratio of 1: 2 and 300 pregnant women including 200 healthy and 100 pregnant women with gestational hypertension were included using the available sampling technique. Data were collected using socio-demographic and obstetrics, Health-promoting behaviors, Self-efficacy, Perceived stress, and Social support questionnaires by the self-report method.ResultsThere was no significant difference in the demographic characteristics between the two groups, except for the spouse's education status. The total score of health-promoting behaviors and social support in the healthy group was significantly higher than women with gestational hypertension. However, the perceived stress in women with gestational hypertension was significantly higher than in the healthy group. In the multivariate analysis, those women with high stress [AOR 1.13, 95% CI (1.08–1.18)] and whose Spouse’s Educational status was low [AOR 4.94, 95% CI (1.54–15.81)] had higher odds of gestational hypertension than women who haven’t respectively. The development of gestational hypertension was decreased by increasing the score of social support [AOR 0.96, 95% CI (0.93–0.98)]. The results showed that the two variables of social support (β=0.331) and self-efficacy (β=0.215) have the greatest impact on the score of health-promotion behaviors, respectively. Based on regression analysis, 21.2% of the health-promotion behaviors changes could be explained by three independent variables.ConclusionWomen with gestational hypertension have unhealthier lifestyles. Having a high level of stress is a risk factor for gestational hypertension but Social support has a protective effect on it. Recognizing the risk factors of gestational hypertension could help the determination of high-risk cases and it is important to pay attention to women's psychosocial to create appropriate sources of social support and provide the necessary action to reduce stress.

Expression and clinical significance of lncRNA NORAD in patients with gestational hypertension.

Gestational hypertension (GH), the most common type of hypertensive disorders in pregnancy, often occurs in women during pregnancy. The purpose of this study was to investigate the expression and clinical significance of lncRNA NORAD in gestational hypertension, and to discuss the possibility of lncRNA NORAD as a diagnostic marker of gestational hypertension. A total of 219 participants were involved in the study. Basic clinical information of all participants was collected, and the expression of NORAD in serum was detected by RT-qPCR. ROC curves were drawn to evaluate the diagnostic value of NORAD expression for gestational hypertension. Multiple linear regression analysis was done to explore the relationship between NORAD and clinical variables. Logistic regression analysis was conducted to analyze the independent influence of different variables on the development of gestational hypertension into preeclampsia. The expression level of NORAD in gestational hypertension was higher than that of healthy individuals, and the expression level of NORAD in preeclampsia was higher than that of gestational hypertension and healthy individuals. The ROC curve suggested that the expression of NORAD has a higher diagnostic value for gestational hypertension. Multiple linear regression analysis showed that systolic blood pressure (SBP) and diastolic blood pressure (DBP) were correlated with the expression of NORAD. SBP, DBP and NORAD were all factors that affect the development of gestational hypertension to preeclampsia, which were known by Logistic regression analysis. LncRNA NORAD may be used as a biomarker for gestational hypertension diagnosis and can influence its progression into preeclampsia.

Paeoniflorin alleviates NG-nitro-L-arginine methyl ester (L-NAME)-induced gestational hypertension and upregulates silent information regulator 2 related enzyme 1 (SIRT1) to reduce H2O2-induced endothelial cell damage

ABSTRACT Pregnancy-induced hypertension (PIH) is a leading cause of maternal mortality. Paeoniflorin has been reported to alleviate hypertension, thus relieving the injury of target organ. This study aimed to investigate the role of paeoniflorin in PIH development by regulating SIRT1 in rats. The mean arterial pressure (MAP), urine protein and histopathological damage of placenta in gestational hypertension rats were, respectively, detected by noninvasive tail-artery pressure measuring instrument, BCA method and H&E staining. The viability of human umbilical vein endothelial cells (HUVECs) treated with paeoniflorin or/and H2O2 was observed by CCK-8 assay. SIRT1 protein expression in HUVECs treated with paeoniflorin or/and H2O2 was analyzed by Western blot. Tunel assay, wound healing assay and tube formation assay were used to detect the apoptosis, migration and tube formation of HUVECs administrated with paeoniflorin or/and H2O2 or/and EX527 (SIRT1 inhibitor). As a result, MAP, urine protein and histopathological damage of placenta were enhanced in PIH rats, which were then alleviated by paeoniflorin. Paeoniflorin decreased the levels of sFlt-1, PlGF and VEGF in serum and placental tissues of gestational hypertension rats as well as the inflammatory response and oxidative stress. In addition, paeoniflorin promoted the expressions of SIRT1 and NO/eNOS and inhibited the production of iNOS in gestational hypertension rats to improve vascular endothelial cell injury. However, SIRT1 inhibition could suppress the protective effects of paeoniflorin on endothelial dysfunction of H2O2-induced HUVECs. In conclusion, paeoniflorin could improve gestational hypertension development by upregulating SIRT1.

First-trimester prediction of gestational hypertension through the bioelectrical impedance analysis of the body composition.

Obesity is a risk factor for the development of gestational hypertension, with important consequences for both the mother and fetus. This prospective observational study aims to propose an early prediction model of hypertensive disorders in pregnancy among obese women, through the bioelectrical impedance analysis (BIA) at the first trimester, thus allowing early recognition of obese women that are at risk to develop gestational hypertension, in order to target preventive interventions. Singleton obese women (BMI ≥ 30 kg/m2) between the 9th and 12th week of pregnancy were included in the study. The exclusion criteria were chronic diseases, like type 2 diabetes mellitus, hypertension, and other medical pre-existing conditions. Eligible women were followed up at 20, 28, and 36 weeks of gestation by measuring blood pressure, weight, and body composition with the use of the BIA. The diagnosis of gestational hypertension was made after the 20th week of gestation. Pregnancy and perinatal outcomes were then recorded. Of the 479 women included in the study, 85 (17.7%) developed gestational hypertension; the remaining 394 (82.3%) resulted to be normotensive. A higher rate of nulliparous women was found in the hypertensive group (50.6% vs. 37.6%, p = 0.02), together with a higher rate of induction of labor (55.3% vs. 40.9%, p = 0.02) and of small for gestational age (SGA) newborns (12.9% vs. 6.9%, p = 0.03). Significant differences emerged in the body composition between the two groups already from the first trimester, indeed women developing gestational hypertension showed elevated values of Total body Mass, FM, FFM, TBW (p < 0.02), and of leg's FM, FFM (p < 0.006). At the multivariate logistics regression, the risk of developing gestational hypertension resulted higher in women with elevated total body water levels in the first trimester (OR 1.10 95% CI 1.04 -1.92). The BIA is a rapid, easy, non-invasive, and inexpensive tool to evaluate the body composition of obese pregnant women. It represents a promising predictor of hypertensive disorders in pregnancy, which allows an early identification of the patients at risk of developing gestational hypertension, thus opening a window of opportunity for strictly monitoring and target preventive intervention.

Increased Uric Acid, Gamma-Glutamyl Transpeptidase and Alkaline Phosphatase in Early-Pregnancy Associated With the Development of Gestational Hypertension and Preeclampsia.

Background: Previous studies have reported that biomarkers of liver injury and renal dysfunction were associated with hypertensive disorders of pregnancy (HDP). However, the associations of these biomarkers in early pregnancy with the risk of HDP and longitudinal blood pressure pattern during pregnancy were rarely investigated in prospective cohort studies.Methods: A total of 1,041 pregnant women were enrolled in this prospective cohort study. BP was assessed in four stages throughout pregnancy. The following biomarkers were measured at early pregnancy before 18 weeks gestation: lactate dehydrogenase (LDH), aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), uric acid (UA), and estimated glomerular filtration rate (eGFR). Linear mixed-effects and logistic regression models were used to examine the associations of these biomarkers with longitudinal BP pattern during pregnancy and HDP incidence, respectively.Results: In unadjusted models, higher serum UA, GGT, ALP, and LDH levels, as well as lower eGFR and AST/ALT, were associated with higher BP levels during pregnancy and an increased risk of HDP. After adjustment for maternal age, pre-pregnancy BMI and other potential confounders, UA, GGT, ALP, and LDH remained positively associated with both BP and HDP. However, eGFR and AST/ALT were not associated with HDP after adjusting for potential confounders. When including all 6 biomarkers simultaneously in multivariable analyses, increased UA, GGT, and ALP significantly associated with gestational hypertension and preeclampsia.Conclusion: This study suggests that increased UA, GGT, and ALP in early-pregnancy are independent risk factors of gestational hypertension and preeclampsia.

The effects of insulin therapy on maternal blood pressure and weight in women with gestational diabetes mellitus

BackgroundAlthough insulin therapy achieves effective glycemic control, it may aggravate hyperinsulinemia. Nonetheless the benefits of insulin as first-line treatment for women with GDM are controversial. This work aimed to investigate the effect of insulin on maternal GDM.MethodsThis retrospective cohort study recruited 708 women with GDM of whom 616 underwent lifestyle intervention and 92 were prescribed insulin therapy. Differences in variables between the two groups were analyzed by univariate analysis and multivariate analysis. Propensity score matching was used to control for age, pre-pregnancy BMI, time and BP at GDM diagnosis, and family history of diabetes and hypertension. Paired sample test was applied to evaluate the changes in BP after intervention in the two groups of women.ResultsThere was no significant difference in mode of delivery, newborn weight or incidence of macrosomia between women prescribed insulin and those who adopted lifestyle modifications. Insulin therapy was associated with a slight increase in maternal weight compared with the lifestyle intervention group and was attributed to short-term treatment (about 12 weeks). In addition, insulin therapy remarkably increased maternal blood pressure, an effect that persisted after matching age, pre-pregnancy BMI, time and BP at GDM diagnosis, and family history of diabetes and hypertension. Between commencing insulin therapy and delivery, systolic blood pressure significantly increased by 6mmHg (P = 0.015) and diastolic blood pressure by 9 mmHg (P < 0.001). Increase in BP was significantly higher in the insulin group compared with the lifestyle intervention group (P < 0.001). Logistic regression analysis with enter selection confirmed that insulin therapy was closely correlated with development of gestational hypertension (GH).ConclusionsThis work suggested that short-term insulin therapy for GDM was associated with a slight increase in maternal weight but a significant risk of increasing maternal blood pressure.